Empowering Women for Zoonotic Malaria Prevention: A Protocol for a Community-Based Participatory Research in Rural Communities (Preprint)

BACKGROUND Background. Zoonotic malaria caused by Plasmodium knowlesi remains a significant public health challenge in rural Sabah, Malaysia. Its complex transmission dynamics, driven by human-animal-environment interactions, challenge conventional malaria control strategies. To address this, a sustainable, community-led prevention model is urgently needed, focusing focus on empowering women in high-risk settings as agents of change Methods. The study will employ Community-Based Participatory Research (CBPR) framework. It will be implemented in six malaria-endemic districts in Sabah: Kudat, Kota Marudu, Ranau, Keningau, Lahad Datu, and Nabawan. A total of 300 women aged 18-65 will be randomly selected from 12 villages, with 32 participants involved in a photovoice study. The research will proceed in three phases: community engagement, data collection, and intervention development. Data will be gathered through baseline and follow-up surveys, photovoice sessions, and observational assessments. Key outcomes include improvements in malaria-related knowledge, attitudes, and practices (KAP), enhanced women’s empowerment and leadership in health promotion, and reduced mosquito exposure behaviours. Community input will guide the co-design of culturally relevant, locally tailored malaria prevention strategies. Dissemination. The study findings will be disseminated through peer-reviewed publications, stakeholder meetings, community photo exhibitions, and presentations at national and international conferences. OBJECTIVE This study protocol describes a study which aims to design, implement, and assess community-driven strategies for the prevention of zoonotic malaria by positioning women as key leaders in malaria control efforts. Using a Community-Based Participatory Research (CBPR) framework, the intervention will train women to recognize malaria risk factors, promote preventive behaviors such as consistent use of insecticide-treated nets (ITNs) and environmental management and advocate for early diagnosis and treatment within their communities. In addition to health education roles, participants will engage in local decision-making processes to enhance collective community capacity for sustainable malaria prevention. By ensuring that the intervention is culturally tailored and community-led, the study seeks to produce actionable insights to inform public health policies and develop a scalable model for malaria prevention in other high-risk, rural settings. METHODS This research will a Community-Based Participatory Research (CBPR) framework [20,21]. Twelve villages across six high-incidence districts of Sabah, Malaysia, will be randomly assigned to intervention or control arms to minimize contamination between groups. Cluster-level randomization ensures that entire villages, rather than individuals, receive consistent intervention exposure. The study will span 12 months, divided into four sequential phases: preparatory engagement, intervention implementation, post-intervention evaluation, and dissemination (Figure 1: Study flowchart) The CBPR approach ensures active community involvement at all stages, from initial engagement to intervention co-development and delivery [20,21]. Participants in intervention villages will undergo structured training focused on malaria prevention, leadership development, and health advocacy, with an emphasis on boosting self-esteem, fostering behavior change, and promoting early health-seeking behavior. The participatory nature of the intervention is intended to cultivate community ownership, enhance cultural relevance, and promote the long-term sustainability of malaria prevention efforts [18]. RESULTS This article presents a study proposal that outlines a Community-Based Participatory Research (CBPR) approach to zoonotic malaria prevention, with a particular focus on empowering women in high-risk, rural communities of Sabah, Malaysia. By positioning women as central stakeholders in malaria control, the proposed intervention aims to promote gender equity while strengthening local capacity for health promotion. Women’s roles as caregivers, educators, and community advocates uniquely position them to lead behaviour change and encourage sustainable malaria prevention practices. As this is a study protocol, no results are available at this stage. CONCLUSIONS As zoonotic malaria transmission in Sabah continues to evolve in response to environment and socio-economic changes, a shift toward community-led contextually grounded interventions becomes increasingly important. The CBPR-based model outlined in this study aims not only to reduce disease burden but also to build long-term resilience among high-risk populations. Achieving sustainable malaria control will require coordinated action among communities, public health systems, and policymakers. Aligning these efforts toward inclusive, locally owned strategies offers a promising pathway toward the ultimate goal of malaria elimination.